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Nearly one in five pregnancies end in early pregnancy loss (EPL), also known as miscarriage, and usually in the first trimester.1 For pregnant people and their families, EPL can be a traumatic experience. This may be further complicated when patients are referred to emergency rooms and unfamiliar specialists for care. While EPL has been managed with dilation and curettage in the operating room, treating EPL in office-based primary care settings is safe, effective, less costly, and acceptable.2 Treatment options include expectant management (“watch and wait”), medication management with misoprostol, and uterine aspiration with manual vacuum aspiration (MVA).3,4 Estimated rates of success to pass an EPL differ slightly by treatment and miscarriage subcategory. With expectant management, by day 14, success rates range from 52%-84%.5 For medication management with one misoprostol dose, success rates range from 81%-93%.6 With MVA, success rates are 98%-100%; it is equally effective as dilation and curettage and has fewer risks of bleeding complications.7 Patients prefer receiving EPL treatment in primary care settings due to privacy, efficiency, and comfort with one’s own clinician.7 Expanding EPL management in these settings may enhance care by offering continuity, thorough information and communication about their EPL, emotional support, and patient-centered counseling for informed decision-making with the patient’s usual clinician.8-11 Outcomes improve when patients actively participate in the decision-making process about how to manage their EPL.12 Family physicians represent over one-third of primary care clinicians in the United States and are most likely to practice in underserved urban and rural communities where

Evaluation of the Miscarriage Care Initiative: A Program to Integrate Comprehensive Early Pregnancy Loss Management in Primary Care Settings